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much smaller, laptop-portable since there's no need for a bulky print-
er, and optimized for musculoskeletal imaging. Plus, they're much
more affordable. "Now they're about $10,000. I have one in every OR,"
says Dr. Lawson.
The end result? Anatomical accuracy, precisely targeted injections,
and more effective regional anesthesia, whether it's a single-shot
block or an indwelling catheter for continuous local anesthesia infu-
sion. "It's proof that you're where you should be. It affords you safety
you don't have with nerve stimulation," he says. "If the patient is not
being served well, it's because practitioners don't know what they're
doing."
A key element of the multimodal approach used at Same Day Joints
in Altoona, Pa., is periarticular injections into the innervated area
around the joint. The anesthesia cocktail blocks sensory but not
motor response, allowing near-immediate post-op ambulation but also
delivering 48 to 72 hours of post-op pain relief.
"Motor-sensory differentiation," says Dave Berkheimer, BSN, CRNA,
the center's co-founder and director of anesthesia as well as the presi-
dent and CEO of RemCare Anesthesia Solutions. "We call it the 'holy
grail of anesthesia.'" Providers have sought a solution for decades as
they attacked the 2 functions together. A study of anesthesia literature
and the combination of inexpensive, off-patent medications led the
Same Day Joints team to develop it in house.
Joint surgery patients are discharged on their feet, without PONV,
with a reduced fall risk, with low pain scores, without even a knee
brace, says Mr. Berkheimer, and they walk out satisfied. "It's really
made a big difference," he says. "And it opens a can of change." OSM
E-mail dbernard@outpatientsurgery.net.
